P0250 - Gastroenterologist Focus of Clinical Practice Affects Adenoma Detection in Screening Colonoscopy

Myunghoon Kim, MD¹, Hadie Razjouyan, MD, MPH (Epi)¹, John Levenick, MD², Kofi Clarke, MD¹, Thomas McGarrity, MD^1
1Penn State University Milton S. Hershey Medical Center and College of Medicine, Hershey, PA; ²Penn State University Milton S. Hershey Medical Center, Hershey, PA

Introduction: Screening colonoscopy stands as the gold standard of preventative care for colorectal cancer. The procedure is done by endoscopists with varying degrees of training. As the percentage of screening colonoscopies increases among the nations, improving the quality of procedures would have significant impact on plausible outcomes. Our objective was to determine whether the clinical focus of practice would affect screening colonoscopy quality metrics, specifically adenoma detection.

Methods: We conducted a retrospective study of screening colonoscopies performed at an academic ambulatory surgical center. We categorized the gastroenterologists based on their clinical subspecialty focus, which includes general/motility, hepatology, inflammatory bowel disease (IBD), and interventional endoscopy. We looked at variables pertaining to the patients’ and providers’ backgrounds and the procedural reports. The primary outcome was adenoma detection (AD) with secondary outcome of adenoma and/or sessile serrated polyp detection (AD+SSP). Multivariable logistic regression analysis was applied.

Results: A total of 5,271 (male: 49.1%) complete first-time screening colonoscopies were performed from 2010 to 2020 by 16 gastroenterologists (male: 62.5%, general/motility specialists: 3, hepatologists: 3, IBD specialists: 4, interventional endoscopists: 6). 87.6% had either adequate, good, or excellent bowel preparation. The AD rate between each specialty focus were 27.5% (n=264) for general/motility, 31.4% (n=409) for hepatology, 38.4% (n=346) for IBD, and 37.5% (n=765) for interventional endoscopy. The AD+SSPs rate between each specialty focus were 31.0% (n=298) for general/motility, 35.5% (n=467) for hepatology, 43.6% (n=396) for IBD, and 43.2% (n=889) for interventional endoscopy. Binary regression analysis was performed with AD and AD+SSP as the outcome of interest, and the results are shown in Table 1. Male gender followed by subspecialty focus of practice, and withdrawal time were independent factors in finding adenomatous polyps. Acceptable bowel preparation enhanced AD+SSP detection in addition to aforementioned factors, table 1.

Discussion: Gastroenterologists met all key quality metrics for screening colonoscopies. However, subspecialty focus of practice is important factor in adenoma detection rate along with patient’s male gender, bowel preparation, and withdrawal time. The result of this study may need further validation with larger multicenter prospective studies.

Variables	Model A Adenoma			Model B Adenoma &/or sessile serrated polyp
	OR	CI (95%)	P-value	OR	CI (95%)	P-value
Male Gender	1.81	1.60-2.05	< 0.001	1.64	1.45-1.86	< 0.001
Acceptable Bowel Preparation	1.17	0.97-1.43	0.106	1.29	1.06-1.56	0.010
Focus of Clinical Practice
General/Motility	1.00	-		1.00	-
Hepatology	1.27	1.03-1.55	0.022	1.30	1.07-1.59	0.008
IBD	1.61	1.30-1.99	< 0.001	1.72	1.39-2.12	< 0.001
Interventional Endoscopy	1.36	1.13-1.64	0.001	1.44	1.20-1.72	< 0.001
Withdrawal Time	1.16	1.14-1.18	< 0.001	1.20	1.18-1.22	< 0.001

Table: Table 1: Regression analysis finding independent factors for detecting polyps. Model A – looking for adenoma. Model B – looking for adenoma and/or sessile serrated polyps. Both models were controlled for the effect of cecum intubation time, provider gender, number of years being out of training. OR = odds ratio; CI = confidence interval


Disclosures:
Myunghoon Kim indicated no relevant financial relationships.
Hadie Razjouyan indicated no relevant financial relationships.
John Levenick indicated no relevant financial relationships.
Kofi Clarke indicated no relevant financial relationships.
Thomas McGarrity indicated no relevant financial relationships.


Myunghoon Kim, MD¹, Hadie Razjouyan, MD, MPH (Epi)¹, John Levenick, MD², Kofi Clarke, MD¹, Thomas McGarrity, MD¹. P0250 - Gastroenterologist Focus of Clinical Practice Affects Adenoma Detection in Screening Colonoscopy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.